Tuesday, June 19, 2012

Community And Professional Concerns Regarding The NEHRS Just Ignored By The Senate. A Sad Day For Democracy.

Well it seems we now have PCEHR Legislation passed the Senate. I think as there are amendments the House will need to finally agree to the completed version before it becomes law. 
Here are two examples from today of concerns being expressed that have been cited to some degree in the Senate but just ignored.

E-health records' security at risk

Fran Molloy
June 19, 2012 - 11:18AM
The national electronic health record database to be launched on July 1 has both medical and security experts calling for better e-health controls.
Australia has no co-ordinated approach to e-health safety and security – and with the national Personally Controlled Electronic Health Record (PCEHR) just weeks away, the risk of a safety crisis is growing daily.
People who choose to register for a PCEHR from July 1 will have access to a range of their medical data from Medicare, and over time also doctor's summaries, pathology results, scans and prescriptions.
"I would rest more comfortably if DOHA [the Department of Health and Ageing] was more pragmatic about the risks involved in accessing personal health records," says Graham Ingram, who heads the information security emergency response centre AusCERT.
"At the moment DOHA is saying, don't worry, the transactions are secure. They are not highlighting the risks that are associated with accessing your information over the internet from a compromised machine."
Ingram wants DOHA to "drop the blanket assurance" that the PCEHR records are safe and says that the risk of identity theft is high, adding DOHA can't guarantee the security of records accessed on a private machine or through an internet café, for example.
A very public security breach occurred last month when DOHA's eHealth education website was defaced by a team of hackers known as 'LatinHackTeam' on May 17.
The hack involved a defacement to publiclearning.ehealth.gov.au. Defacements are the digital equivalent to a protest graffiti. In this case it included a homepage change with text celebrating it.
Heaps more here:
and also here:

E-health record service delayed by incomplete infrastructure

PLANS for Health Minister Tanya Plibersek to mark the start of the $1.1 billion e-health record service are on hold, as key parts of the system are not ready for the much-feted July 1 launch.
Sources who declined to be named say a ceremony planned at St Vincent's Hospital in Sydney on Monday, July 2 -- the first working day of the new system -- has been cancelled.
The minister's office was tight-lipped when The Australian asked whether the event had been postponed to a later date.
"We look forward to the launch of e-health, an important government reform that will cut down on medical errors and mean patients won't have to repeat their medical history every time they see a new doctor," her spokesman said.
He would not provide any details of plans for the introduction of the government's personally controlled e-health record system, first mooted in early 2010.
St Vincent's & Mater Health Sydney is running one of the more successful PCEHR pilots, reporting last month that it had recruited 4546 consumers to its Eastern Sydney Connect shared e-health record, out of a hoped-for 46,800 participants.
The minister and her department spokespeople also had no comment on a recent visit from Peter Fleming, chief executive of the National E-Health Transition Authority, to deliver bad news on a number of fronts.
These include the lack of readiness of the national IT infrastructure, being built to NEHTA specifications by an Accenture-Oracle consortium at a cost of $91 million. It is yet to go live.
Much more here:
So we have the Fairfax and the News Limited press providing detailed information on what an unsafe and unready mess this all is. Sadly the pollies haven’t noticed.
It was fascinating to hear Senator Di Natalie (Greens) point out that the Opposition speech would be taken as expressing grave concerns about the plans - but that the Opposition was still then going on and passing the legislation anyway! It all feels very, very odd to me.
Listening to the debate - the complexities of Health IT are just totally beyond these poor benighted Senators. Sadly they are just clueless.
Additionally the Labor Senators are using the ‘Tassie Health Bailout’ as a way of avoiding talking about the mess that the NEHRS / PCEHR has become!
Senator Polly (Lab) from Tasmania is totally out of touch with the reality and complexity of all this!
She also loves to witter on about Tasmania’s bail-out.
Senator Mason (Lib)  - not clear on costs and not clear on what use we will see. Also asks just why GPs will get involved and the lack of consultation. Also really concerned about the effect on patients of having this information in a central place!
Senator Boyce (Lib).  - NEHTA has not been honest and transparent - but still support it. NEHTA has messed up and now we have a ‘soft launch’. Why is that?
Apparently 32 amendments are proposed by the Government - these will need close review in due course.
The Bill was passed 6:04pm - God help us all! What a farce!
Well we will now have to wait quietly, see the Reps pass the Bills, and then see just how little gets delivered as the costs just rise!
What a mess.


Anonymous said...

From what it sounds like..
The systems have not been finished even for the test sites. <10% of the test site patients have been recruited. Not even 3 months of real world testing the complete system will happen before October 1, 2012. The data from GP's and hospitals are yet to be added. Functionality for data from Path & imaging are yet to be added. Disease, symptoms, path, imaging, medicines are unsearchable or unreliable free text. Coding and classification systems at the end of a 2014+ timetable. Data silos for GP data are yet to be created and who is going to pay for them ?

Grahame Grieve said...

With regard to coding, the data will be provided with whatever coding the source clinical systems use. This is not the same as "unsearchable or unreliable free text" (though no nirvana, that's for sure).

Since the limitation here is not technical, but in terms of clinical record keeping standards, does TimC have any suggestions for how to progress the situation?

Anonymous said...

Re Grahame Grieve said: this illustrates the folly of technology over everything else.

IE it is no good applying technology when it is not a technology issue to solve.

Just look at where it got QH rePayroll. A key issue was not a technology issue to solve - rather it was an award consolidation and work practice issue to solve. Applying technology gave a customise to death senario.

Similarly, terminologies is a real sleeper here. Its not a technology issue to solve but a medical community consensus issue and clinical coding/record keeping/data management issue to solve.


Grahame Grieve said...

err, it's a long leap from what I said to "this is not a technology issue to solve". An ignorant one. This is a problem at all levels, and all levels need solutions. The clinical community can't solve this problem in the absence of technology either